Impact of portal vein thrombosis on adult to adult LDLT: 8 years experience

Abstract

Background and Objective: Living donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) involves technical difficulty. Its presence has frequently been presented as a relative or absolute contraindication in LDLT by numerous groups. The aim of this study is to demonstrate our experience in dealing with patients with preexisting PVT and its effect on the outcome of transplantation. Methods: From October 2001 to September 2009, 210 LDLT were performed by our team. Thirty one patients with intraoperatively confirmed nontumoral PVT formed the study group. The thrombus was removed by a simple technique of eversion thrombectomy. Anticoagulation was started after surgery to be stopped 6 months after confirmation of absence of PVT. A comparative analysis with intraoperative and postoperative variables was performed with 179 patients without PVT transplanted in the same period. Results: PVT was diagnosed preoperatively in 15 (48%) patients. The commonest type was grade II, occurring in 13(41.9%) patients. Total thrombectomy was successful in 29 cases and partial in two cases, but with adequate portal flow.The overall complications, Infections and portal vein rethrombosis were higher in patients with preexisting PVT but this was not associated with increase in ICU or hospital stay. PVT did not affect patient survival (70.6% and 60.2%, one and three year survival rate in patients with PVT vs. 81% and 62% in patients without PVT). Conclusion: PVT increases surgical difficulties and postoperative morbidity (PV rethrombosis, infections) but does not have an influence on patients survival.